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Discussion

Is this normal?

  • Experts

At my teaching hospital, as at any other, the residents perform procedures such as central line insertions, trialysis insertions, a lines, etc. For the majority of these procedures, the residents are alone with the senior teaching or showing the intern. Each procedure note is cosigned by the attending, stating that they were present for the entire procedure. Well, most of the time, this is untrue. Just a blatant lie for the legal medical record. Such as the other night, when the attending was sleeping and did not show his/her face in the unit at any point in time...yet according to the charts, he was present for at least 4 procedures on that shift alone.

Is this a normal practice at other institutions??

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    • Experts

    I've never worked in a teaching hospital, so I couldn't tell you whether what you describe is normal behavior.

    However, I've seen physicians either handwrite or dictate a progress note for patients prior to ever entering the room to lay eyes on them. The physician just dictated that the patient's heart rhythm was 'regular,' but had not yet seen the patient.

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    Not at my teaching hospital. At least not on my unit.

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    • Experts

    I see it all the time. Attendings state they discussed the medical POC with nursing, and I didn't even see them on the floor. Surgical notes pop up in the notes section, and I know the surgeon hasn't even seen the patient yet. Invasive bedside procedures completed with just the second year resident there, but notes state a full MD/DO was.

    In fact, I don't think the surgeon I spoke with prior to one of my surgeries actually operated on me. I know that the chief resident did (a 5th year surgical resident) because he was the one who wrote my intraop note with the notation that the surgeon was present for the entire procedure. That does not make me happy that I wasn't told that someone else completely would be doing the operation, even if supervised. However, I believe this type of thing might be very common.

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    Very common. Where I did residency I needed 15 central lines to be "signed off" to do them solo. I was supervised by a senior until I hit them which I did probably 6 months into intern year. Still we had a rule that as interns someone supervised so after I hit 15 a senior would sit in the room. I rarely was supervised by an attending. After intern year as long as I had hit my 15 I could put in a CVL solo or supervise an intern. I always documented "Dr. Attending was available and the supervising physician for the procedure." If I documented "Dr. Attending was present for the procedure" I feel like that would be wrong. Obviously available ranged from holding my hand to sleeping in the call room.

    Still this is common place. Most places have a credentialing committee. Like I said my institution credentialed at 15 CVL's so if we hit that we were essentially signed off. Still when I was signed off it was essentially up to the Attending how confident they were. If they wanted to be right beside me they could but if they wanted to sleep could do that also.

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    • Experts

    Not a teaching hospital situation, but at a long term care facility, doctors would swoop in and write progress notes on their residents without seeing them at all. The only way we knew they had been there was because the note appeared "by magic" and they left the charts strewn all over the nurse station. Common practice, I was told.

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